Provider Demographics
NPI:1477146405
Name:WHOLESOME WELLNESS LLC
Entity Type:Organization
Organization Name:WHOLESOME WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-613-8130
Mailing Address - Street 1:6830 MEADOW VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3994
Mailing Address - Country:US
Mailing Address - Phone:219-613-8130
Mailing Address - Fax:
Practice Address - Street 1:6830 MEADOW VIEW LN
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3994
Practice Address - Country:US
Practice Address - Phone:219-613-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center